Community-based organizations in the fight against HIV
Counselors, mentor mothers, and other local healthcare workers connect with patients and their families to ensure they receive empathetic care while coordinating with health facility providers to facilitate quality clinical care.
The USAID Efficiencies for Clinical HIV Outcomes (ECHO) project supports community-based organizations, in Manica, Tete, Niassa, and Sofala provinces, to connect patients to HIV testing and treatment.
When the USAID ECHO activity began in 2019, many Mozambicans living with HIV were underutilizing public healthcare services, making it difficult to provide on-going treatment and support. To tackle this challenge, it became essential to invest in long-term, sustainable relationships between community workers, providers, and patients. The ECHO project builds community capacity for outreach, treatment, and counseling while also supporting basic care and treatment for people living with HIV.
Prior to ECHO people living with HIV had to proactively go to healthcare facilities to seek services and support. Stigma, lack of information and misconceptions about HIV were all barriers to accessing public testing and treatment services. This changed when ECHO began empowering community health workers to provide HIV testing, treatment and counseling services beyond the walls of healthcare facilities.
ECHO works with community based organizations, such as the Christian Council of Mozambique (CCM) in Sofala, to train healthcare workers and community volunteers to conduct in-home visits where community members are provided with information and support for HIV testing, treatment, prevention and counseling.
Left: Mentor mother, assigned to Health Center Number 2 in Tete province, carries out HIV testing for the minor children of an HIV-positive couple. Right: Mentor mother, assigned to Health Center Number 2 in Tete province, collecting a blood sample to carry out community testing of a child born to HIV-positive parents.
“When I took the HIV test, the mentor mother gave me all the support so that I could continue with the treatment and actively participate in the prenatal consultations. Because of that, my wife and I had a healthy baby.”
Armando Manuel, seropositive patient on antiretroviral treatment in Sofala province
Paula and Armando Manuel, recently benefited from this approach. Paula, 27-years-old, became pregnant with her third child in 2020. She was then diagnosed with HIV during a standard ante-natal consultation at her local health facility. After her visit, she was assigned a ‘mentor mother’ who coached Paula through the emotional process of disclosing her diagnosis to her husband, Armando. Community-based health workers visited Paula and Armando at their home to test Armando and their two children. Armando tested positive and their children were both negative. Throughout Paula’s pregnancy, mentor mothers frequently visited the family at home to provide consultative and emotional support. Postpartum, the couple knew which medicine to administer and regularly took their newborn to at-risk child consultations.
The robust support that they received was thanks, in part, to CCM, a community-based organization in Sofala province that deploys community actors to create linkages between patients and health facilities. Through strong partnerships with health facilities, CCM community workers ensure that a patient’s counseling and clinical care is high quality and empathetic. Community counselors and health workers helped Paula and Armando navigate the challenging process of pregnancy and childbirth in parallel with an HIV diagnosis. We are pleased to report that testing later confirmed their new baby boy was born healthy and HIV negative.
Left: Mentor mother, allocated to Health Center Number 2 in Tete province, visit the patients' homes, to follow up on their treatment and test their family. Center: A woman that missed HIV care and treatment appointments after receiving antiretroviral drugs in community dispensation. Right: Health provider dispensing antiretroviral drugs to an absent patient in the community.
With these local, patient-centered approaches, treatment drop-outs and mother-to-child transmission rates have declined. Across the four provinces where ECHO operates, positivity rates for at-risk children whose mothers were diagnosed with HIV have fallen from 5% in 2019 to now only 2.3%. Patient drop-outs fell from 32,059 patients abandoning their therapy in 2019 to now just 6,754 patients. ECHO’s outreach strategies and deep engagement of community actors is strengthening local resources for the fight against HIV in Mozambique.
ECHO is the USAID five-year flagship clinical program for HIV/AIDS clinical care and treatment. The project works in 148 health facilities in Sofala, Manica, Tete and Niassa provinces, providing support to the government of Mozambique to expand targeted HIV testing, ensure HIV-positive individuals receive treatment, stay in treatment, and reduce their viral load to bring the virus under control.